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[PMID]:28414397
[Au] Autor:Blume HK
[Ti] Título:Childhood Headache: A Brief Review.
[So] Source:Pediatr Ann;46(4):e155-e165, 2017 Apr 01.
[Is] ISSN:1938-2359
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Headaches are common in childhood and adolescence and can cause significant distress and disability for a child and their family. Providers need to be able to identify "red flags" for worrisome causes of secondary headaches and recognize typical primary headache characteristics to provide each patient with the best possible care to improve their quality of life and minimize disability. This article reviews the epidemiology of headaches in children, signs and symptoms of secondary headaches, definitions of some primary childhood headaches, and options for management of both acute and chronic pediatric migraine. [Pediatr Ann. 2017;46(4):e155-e165.].
[Mh] Termos MeSH primário: Transtornos da Cefaleia Primários
Cefaleia
[Mh] Termos MeSH secundário: Criança
Terapia Combinada
Cefaleia/diagnóstico
Cefaleia/epidemiologia
Cefaleia/etiologia
Cefaleia/terapia
Transtornos da Cefaleia Primários/diagnóstico
Transtornos da Cefaleia Primários/epidemiologia
Transtornos da Cefaleia Primários/terapia
Seres Humanos
Anamnese
Neuroimagem
Exame Físico
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170418
[St] Status:MEDLINE
[do] DOI:10.3928/19382359-20170321-02


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[PMID]:28410263
[Au] Autor:Ramming M; Bansbach J; Beck C; Kalbhenn J
[Ad] Endereço:From the *Department of Anesthesiology and Critical Care, University of Freiburg Medical Center, Freiburg, Germany; and †Department of Neuroradiology, University of Freiburg Medical Center, Freiburg, Germany.
[Ti] Título:Volatile Sedation in Reversible Cerebral Vasoconstriction Syndrome: A Case Report.
[So] Source:A A Case Rep;9(2):42-46, 2017 Jul 15.
[Is] ISSN:2325-7237
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by reversible multifocal narrowing of cerebral arteries heralded by sudden (thunderclap) headaches with or without neurological deficits, resolving within 3 months. It often occurs in the peripartum period. To date, the ideal treatment remains unclear. Here, we report the case of a 31-year-old primigravida who presented with intracranial hemorrhage and went on to develop RCVS and acute respiratory distress syndrome over the course of her illness. Her condition was further complicated by uterine atony and septic shock.We describe for the first time the use of short-acting volatile sedation for prone positioning in acute respiratory distress syndrome during RCVS.
[Mh] Termos MeSH primário: Sedação Consciente/métodos
Transtornos da Cefaleia Primários/terapia
Complicações na Gravidez/terapia
[Mh] Termos MeSH secundário: Adulto
Circulação Cerebrovascular
Angiografia por Tomografia Computadorizada
Feminino
Transtornos da Cefaleia Primários/complicações
Transtornos da Cefaleia Primários/diagnóstico por imagem
Seres Humanos
Hemorragias Intracranianas/complicações
Angiografia por Ressonância Magnética
Neuroimagem/métodos
Gravidez
Síndrome do Desconforto Respiratório do Adulto/complicações
Síndrome
Ultrassonografia Doppler Transcraniana
Vasoconstrição
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170415
[St] Status:MEDLINE
[do] DOI:10.1213/XAA.0000000000000521


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[PMID]:28401499
[Au] Autor:Kim DY; Lee MJ; Choi HA; Choi H; Chung CS
[Ad] Endereço:Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
[Ti] Título:Clinical patterns of primary stabbing headache: a single clinic-based prospective study.
[So] Source:J Headache Pain;18(1):44, 2017 Dec.
[Is] ISSN:1129-2377
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The clinical features and disease courses of primary stabbing headache (PSH) are diverse. We aimed to identify distinct clinical patterns of PSH. METHODS: We prospectively screened consecutive first-visit patients who presented with stabbing headache at the Samsung Medical Centre Headache Clinic from June 2015 to March 2016. Demographics, headache characteristics, and disease courses were prospectively evaluated. After discerning factors related to the chronicity at the time of presentation, clinical patterns were identified based on the frequency (daily vs. intermittent), clinical course (remitted or not), and total disease duration (<3 or >3 months). RESULTS: In the 65 patients with PSH included in this study, monophasic (n = 31), intermittent (n = 17), and chronic daily (n = 12) patterns were identified. The median disease durations were 9 days for monophasic PSH, 9 months for chronic daily PSH, and 2 years for intermittent PSH. The features of monophasic PSH were greater severity, single and side-locked locations, more attacks per day, daily occurrence, and good treatment response. Chronic daily PSH was associated with female predominance, longer-lasting stabs, and multiple or migrating locations on bilateral or alternating sides. The characteristics of intermittent PSH included female predominance and sporadic stabs with less intensity. CONCLUSIONS: Our study demonstrated distinct clinical patterns of PSH. In addition to help early recognition of disease, our findings suggest different pathophysiologic mechanisms. Future prospective studies are required to reveal the etiologies of these different PSH patterns and their optimal treatment strategies.
[Mh] Termos MeSH primário: Progressão da Doença
Transtornos da Cefaleia Primários/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170529
[Lr] Data última revisão:
170529
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170413
[St] Status:MEDLINE
[do] DOI:10.1186/s10194-017-0749-7


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[PMID]:28320115
[Au] Autor:Anzola GP; Brighenti R; Cobelli M; Giossi A; Mazzucco S; Olivato S; Pari E; Piras MP; Padovani A; Rinaldi F; Turri G
[Ad] Endereço:Villa Gemma Hospital, Gardone Riviera, Italy. Electronic address: gpanzola@gmail.com.
[Ti] Título:Reversible cerebral vasoconstriction syndrome in puerperium: A prospective study.
[So] Source:J Neurol Sci;375:130-136, 2017 Apr 15.
[Is] ISSN:1878-5883
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND AIM OF THE STUDY: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe "thunderclap" headache, with or without associated neurological symptoms and neuroimaging findings of reversible vasoconstriction of cerebral arteries. Puerperium is a recognized precipitant, but the incidence of puerperal RCVS is unknown. We conducted a prospective study to assess incidence, risk factors and clinical features of RCVS. MATERIAL AND METHOD: Nine-hundred consecutive puerperae were prospectively enrolled within three days of delivery. Past medical history, basal demographic, anthropometric and biological variables were recorded. Transcranial Colour Coded Sonography (TCCS) was performed to assess early signs of vasospasm in brain vessels. A structured telephone interview was planned in all subjects one month postdelivery. RESULTS: Thunderclap headache was recorded in 8 subjects (0.9%) on the first visit. At the one month follow-up interview 27 more patients reported having had at least one episode of thunderclap headache. In these 33 (3.8%) patients the course was spontaneously benign. One patient presented to the Emergency ward with throbbing thunderclap headache three weeks after delivery. Diagnostic work-up ended up in the diagnosis of RCVS, the outcome was favourable CONCLUSION: In normally coursing pregnancies and after uncomplicated delivery the risk of puerperal RCVS is negligible (0.1%). On the other way thunderclap headache may occur in a measurable proportion of (3.4%), although in the vast majority of cases (33/34=97%) it is of benign course. Transcranial Doppler sonography may be helpful to pick up those cases in whom further neuroradiological investigation is warranted.
[Mh] Termos MeSH primário: Transtornos da Cefaleia Primários/diagnóstico por imagem
Período Pós-Parto
Ultrassonografia Doppler Transcraniana
Vasoespasmo Intracraniano/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Angiografia por Ressonância Magnética
Imagem por Ressonância Magnética
Meia-Idade
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170703
[Lr] Data última revisão:
170703
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170322
[St] Status:MEDLINE


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[PMID]:28229320
[Au] Autor:Herekar AA; Ahmad A; Uqaili UL; Ahmed B; Effendi J; Alvi SZ; Shahab MA; Javed U; Herekar AD; Khanani R; Steiner TJ
[Ad] Endereço:Headache Research Foundation of Pakistan, Karachi, Pakistan.
[Ti] Título:Primary headache disorders in the adult general population of Pakistan - a cross sectional nationwide prevalence survey.
[So] Source:J Headache Pain;18(1):28, 2017 Dec.
[Is] ISSN:1129-2377
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The large geographical gaps in our knowledge of the prevalence and burden of headache disorders include almost all of Eastern Mediterranean Region (EMR). We report a nationwide population-based study in Pakistan, an EMR country with the sixth largest population in the world, conducted as a project within the Global Campaign against Headache. METHODS: We surveyed six locations from the four provinces of Pakistan: Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan. We randomly selected and visited rural and urban households in each. One adult member (18-65 years) of each household, also randomly selected, was interviewed by a trained non-medical interviewer from the same location using a previously-validated structured questionnaire translated into Urdu, the national language. We estimated 1-year prevalences of the headache disorders of public-health importance and examined their associations with demographic variables using multivariate analysis. RESULTS: There were 4223 participants (mean age 34.4 ± 11.0 years; male 1957 [46.3%], female 2266 [53.7%]; urban 1443 [34.2%], rural 2780 [65.8%]). Participation proportion was 89.5%. Headache in the previous year was reported by 3233 (76.6% [95% CI: 75.3-77.8%]). The age- and gender-adjusted 1-year prevalence of migraine was 22.5% [21.2-23.8%] (male 18.0% [16.8-19.2%], female 26.9% [25.6-28.2%]), of tension-type headache (TTH) 44.6% [43.1-46.1%] (male 51.2% [49.7-52.7%], female 37.9% [36.4-39.4%]), of probable medication-overuse headache 0.7% [0.5-1.0%] (male 0.7% [0.5-1.0%], female 0.8% [0.5-1.1%]) and of other headache on ≥15 days/month 7.4% [6.6-8.2%] (male 4.4% [3.8-5.0%], female 10.4% [9.5-11.3%]). Migraine was more prevalent in females by a factor of 3:2 although this association barely survived (P = 0.039) after correcting for other factors. TTH was more prevalent in males by about 4:3 (P = 0.026). All headache and migraine were age-related, peaking in the age group 40-49 years; TTH peaked a decade earlier. Higher education (P = 0.004) and income (P = 0.001) were negatively associated with prevalence of migraine. CONCLUSION: With three quarters of its population affected, headache disorders must be on the public-health agenda of Pakistan. Worldwide, these disorders are the third leading cause of disability; information from specific enquiry into the burden attributable to headache disorders in this country is needed to inform health policy and priority-setting, and will be reported soon.
[Mh] Termos MeSH primário: Transtornos da Cefaleia Primários/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Estudos Transversais
Feminino
Transtornos da Cefaleia Secundários/epidemiologia
Seres Humanos
Masculino
Meia-Idade
Transtornos de Enxaqueca/epidemiologia
Paquistão/epidemiologia
Prevalência
Cefaleia do Tipo Tensional/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170428
[Lr] Data última revisão:
170428
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170224
[St] Status:MEDLINE
[do] DOI:10.1186/s10194-017-0734-1


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[PMID]:28195428
[Au] Autor:Lee MJ; Cha J; Choi HA; Woo SY; Kim S; Wang SJ; Chung CS
[Ad] Endereço:Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
[Ti] Título:Blood-brain barrier breakdown in reversible cerebral vasoconstriction syndrome: Implications for pathophysiology and diagnosis.
[So] Source:Ann Neurol;81(3):454-466, 2017 Mar.
[Is] ISSN:1531-8249
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Diagnosis of reversible cerebral vasoconstriction syndrome (RCVS) is currently based on luminographic findings of vasoconstriction. In addition to vasoconstriction, the blood-brain barrier (BBB) breakdown has been postulated as a central mechanism of RCVS. Our aim was to document BBB breakdown in patients with RCVS and its role for the pathophysiology-based diagnosis of RCVS. METHODS: We prospectively recruited 72 consecutive patients with thunderclap headache who did not have aneurysmal subarachnoid hemorrhage from April 2015 to July 2016 at the Samsung Medical Center. Based on the International Classification of Headache Disorders-3 beta criteria and neuroimaging, patients were classified as having RCVS (n = 41; "definite" in 29 imaging-proven patients and "probable" in 12 imaging-negative patients), other secondary causes (n = 7), and thunderclap headache of undetermined cause (n = 24). BBB breakdown was evaluated using contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging. RESULTS: BBB breakdown was documented in 20 (69.0%) patients with definite RCVS, 3 (25.0%) patients with probable RCVS, and none with other secondary causes. BBB breakdown was present in RCVS patients with (n = 4) and without (n = 19) concomitant posterior reversible encephalopathy syndrome. In patients with RCVS, the extent of BBB breakdown was independently associated with neurological complications (multivariate odds ratio = 1.48 per 1 territorial increase, 95% confidence interval = 1.04-2.12, adjusted p = 0.032). Three (12.5%) patients with thunderclap headache of undetermined cause were newly classified as having RCVS by the presence of BBB breakdown. INTERPRETATION: This is the first study to show BBB breakdown in patients with RCVS. This finding might broaden our understanding of the pathophysiology and clinical spectrum of RCVS. Ann Neurol 2017;81:454-466.
[Mh] Termos MeSH primário: Barreira Hematoencefálica/diagnóstico por imagem
Doenças Arteriais Cerebrais/diagnóstico por imagem
Transtornos da Cefaleia Primários/diagnóstico por imagem
Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem
Vasoconstrição/fisiologia
[Mh] Termos MeSH secundário: Adulto
Doenças Arteriais Cerebrais/líquido cefalorraquidiano
Doenças Arteriais Cerebrais/epidemiologia
Doenças Arteriais Cerebrais/fisiopatologia
Comorbidade
Feminino
Transtornos da Cefaleia Primários/líquido cefalorraquidiano
Transtornos da Cefaleia Primários/epidemiologia
Transtornos da Cefaleia Primários/fisiopatologia
Seres Humanos
Masculino
Meia-Idade
Síndrome da Leucoencefalopatia Posterior/líquido cefalorraquidiano
Síndrome da Leucoencefalopatia Posterior/epidemiologia
Síndrome da Leucoencefalopatia Posterior/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170630
[Lr] Data última revisão:
170630
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170215
[St] Status:MEDLINE
[do] DOI:10.1002/ana.24891


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[PMID]:28159327
[Au] Autor:Przeklasa-Muszynska A; Skrzypiec K; Kocot-Kepska M; Dobrogowski J; Wiatr M; Mika J
[Ad] Endereço:Department of Pain Research and Treatment, Chair of Anesthesiology and Intensive Therapy, Medical College of Jagiellonian University, Krakow, Poland. Electronic address: aprzemusz@wp.pl.
[Ti] Título:Non-invasive transcutaneous Supraorbital Neurostimulation (tSNS) using Cefaly device in prevention of primary headaches.
[So] Source:Neurol Neurochir Pol;51(2):127-134, 2017 Mar - Apr.
[Is] ISSN:0028-3843
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:Headaches are one of the most common pain syndromes experienced by adult patients. International Classification of Headache Disorders identifies about 300 different entities. Primary headaches (migraine, tension-type headache, trigeminal autonomic cephalalgias, other primary headaches) has the common occurrence. Although effective treatment of these disorders is possible, it is inefficient or poorly tolerated in some patients. Neuromodulation methods, being element of multimodal treatment, provide an additional treatment option in pharmacotherapy-refractory patients. Both invasive and non-invasive stimulation methods are used. The non-invasive techniques is transcutaneous nerve stimulation using Cefaly device. In this study, Cefaly was used as prevention treatment in patients with pharmacotherapy-refractory headaches. This device is indicated for the prophylactic treatment of episodic primary headaches. A total of 91-patients (30 without and 61 with tSNS) were enrolled in the study, including 60-patients with migraine and 31-patients with other primary headaches. Ten courses of non-invasive peripheral (supraorbitral/supratrochlear) nerves stimulation were delivered to 57-patients; in the remaining 4 patients, the treatment was abandoned due to poor tolerance. Patients were observed for 30 days after stimulation treatment. Compared to the pre-treatment period, the reduction in the intensity of pain was observed in both the migraine group and patients with other types of headaches; this included the number of pain episodes being reduced by half, with simultaneous reduction in average pain intensity and duration of individual pain episodes. The subjective assessment of pain reduction was in the range of 40-47%. Based on our data we recommend tSNS as useful tool in the prophylaxis of primary headaches, including migraine.
[Mh] Termos MeSH primário: Transtornos da Cefaleia Primários/prevenção & controle
Transtornos de Enxaqueca/prevenção & controle
Estimulação Elétrica Nervosa Transcutânea/instrumentação
[Mh] Termos MeSH secundário: Adulto
Idoso
Desenho de Equipamento
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Medição da Dor
Aceitação pelo Paciente de Cuidados de Saúde
Prevenção Secundária
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170205
[St] Status:MEDLINE


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[PMID]:28038897
[Au] Autor:Costa I; Mendonça MD; Cruz E Silva V; Calado S; Viana-Baptista M
[Ad] Endereço:Internal Medicine Department, Hospital Egas Moniz-Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
[Ti] Título:Herbal Supplements Association with Reversible Cerebral Vasoconstriction Syndrome: A Case Report.
[So] Source:J Stroke Cerebrovasc Dis;26(3):673-676, 2017 Mar.
[Is] ISSN:1532-8511
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Reversible cerebral vasoconstriction syndrome (RCVS) is a clinico-radiologic syndrome characterized by thunderclap headache and reversible multifocal arterial constrictions that resolves within 3 months. RCVS can be either spontaneous or related to a trigger; vasoactive drugs including over-the-counter medicine are common culprits. Nevertheless, there are sparse data on the association of herbal supplements in the genesis of unexplained RCVS. METHODS: We describe a case of RCVS with a temporal association with the consumption of a diet pill composed of green tea, L-carnitine, and conjugated linoleic acid. We reviewed the literature describing RCVS cases associated with consumption of herbal supplements or plants. RESULTS: A 50-year-old black woman presented at the emergency room with a thunderclap headache less than 1 week after beginning a new herbal supplement with weight loss purpose. Angiographic study revealed multiple arterial constriction of virtually all intracranial territories that were reversed 28 days later. The patient was discharged with minimal symptoms. From our review, we identified 5 previous reports of herbal product-related triggers. CONCLUSIONS: Different factors can trigger RCVS. Besides our case, at least 5 other nutraceutical products were described to be associated with the disorders, 3 of them in patients without any other clear cause. Clinicians should be aware of the possible role of herbal supplements in RCVS, and their use should be systematically assessed in large RCVS cohorts to clarify this association.
[Mh] Termos MeSH primário: Transtornos da Cefaleia Primários/induzido quimicamente
Plantas Medicinais/efeitos adversos
[Mh] Termos MeSH secundário: Bases de Dados Bibliográficas/estatística & dados numéricos
Feminino
Transtornos da Cefaleia Primários/diagnóstico por imagem
Seres Humanos
Angiografia por Ressonância Magnética
Imagem por Ressonância Magnética
Meia-Idade
Hemorragia Subaracnóidea/induzido quimicamente
Hemorragia Subaracnóidea/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170602
[Lr] Data última revisão:
170602
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170101
[St] Status:MEDLINE


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[PMID]:28025831
[Au] Autor:Evans RW; Timm JS
[Ad] Endereço:Department of Neurology, Baylor College of Medicine, 1200 Binz #1370, Houston, TX, USA.
[Ti] Título:New Daily Persistent Headache Caused by a Multinodular Goiter and Headaches Associated With Thyroid Disease.
[So] Source:Headache;57(2):285-289, 2017 Feb.
[Is] ISSN:1526-4610
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A 33-year-old female is presented with the first case to our knowledge of new daily persistent headache (NDPH) with a large right benign non-toxic multinodular goiter causing carotid and vertebral compression with complete resolution of the headache immediately after thyroidectomy. Although this may be quite rare, hypothyroidism or hyperthyroidism causing NDPH, migraine, or an exacerbation of pre-existing migraine is not. Clinicians should consider routinely obtaining serum thyroid-stimulating hormone (TSH) and free T4 in patients with new onset frequent headaches or an exacerbation of prior primary headaches.
[Mh] Termos MeSH primário: Bócio Nodular/complicações
Transtornos da Cefaleia Primários/etiologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Bócio Nodular/diagnóstico por imagem
Bócio Nodular/cirurgia
Cefaleia/diagnóstico por imagem
Cefaleia/etiologia
Cefaleia/terapia
Transtornos da Cefaleia Primários/diagnóstico por imagem
Transtornos da Cefaleia Primários/terapia
Seres Humanos
Tireoidectomia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161228
[St] Status:MEDLINE
[do] DOI:10.1111/head.13011


  10 / 663 MEDLINE  
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[PMID]:27940651
[Au] Autor:Singhal AB; Topcuoglu MA
[Ad] Endereço:From Massachusetts General Hospital and Harvard Medical School (A.B.S., M.A.T.), Boston; and Neurology Department (M.A.T.), Hacettepe University Hospitals, Ankara, Turkey. asinghal@partners.org.
[Ti] Título:Glucocorticoid-associated worsening in reversible cerebral vasoconstriction syndrome.
[So] Source:Neurology;88(3):228-236, 2017 Jan 17.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Factors predicting poor outcome in patients with the reversible cerebral vasoconstriction syndrome (RCVS) have not been identified. METHODS: In this single-center retrospective study, we analyzed the clinical, brain imaging, and angiography data in 162 patients with RCVS. Univariable and multivariable regression analysis were performed to identify predictors of persistent (nontransient) clinical worsening, radiologic worsening, early angiographic progression, and poor discharge outcome (modified Rankin Scale score 4-6). RESULTS: The mean age was 44 ± 13 years; 78% of patients were women. Persistent clinical worsening occurred in 14% at 6.6 ± 4.1 days after symptom onset, radiologic worsening in 27% (mainly new infarcts), and angiographic progression in 15%. Clinical worsening correlated with angiographic progression and new nonhemorrhagic lesions. Age and sex did not independently predict any type of worsening. Infarction on baseline imaging predicted poor outcome. Prior serotonergic antidepressant use predicted clinical and angiographic worsening but not poor outcome. Intra-arterial vasodilator therapy independently predicted clinical worsening and poor discharge outcome but was offered to more severe cases. Glucocorticoid treatment proved to be an independent predictor of clinical, imaging, and angiographic worsening and poor outcome. Of the 23 patients with clinical worsening, 17 received glucocorticoids (15 within the preceding 2 days). There were no significant differences in baseline brain lesions and angiographic abnormalities between glucocorticoid-treated and untreated patients. CONCLUSION: Patients with RCVS at risk for worsening can be identified on basis of baseline features. Iatrogenic factors such as glucocorticoid exposure may contribute to worsening.
[Mh] Termos MeSH primário: Glucocorticoides/efeitos adversos
Vasoespasmo Intracraniano/induzido quimicamente
[Mh] Termos MeSH secundário: Adulto
Angiografia Cerebral
Progressão da Doença
Vias de Administração de Medicamentos
Feminino
Seguimentos
Glucocorticoides/administração & dosagem
Glucocorticoides/uso terapêutico
Transtornos da Cefaleia Primários/induzido quimicamente
Transtornos da Cefaleia Primários/diagnóstico por imagem
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Metilprednisolona/uso terapêutico
Meia-Idade
Análise de Regressão
Estudos Retrospectivos
Vasoespasmo Intracraniano/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Glucocorticoids); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170519
[Lr] Data última revisão:
170519
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161213
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000003510



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